Medications and Toxins
One important cause of rhabdomyolysis that many people are exposed to isstatin (cholesterol lowering) medications. Statins include atorvastatin (Lipitor), rosuvastatin (Crestor), pravastatin (Pravachol), etc. Although rhabdomyolysis only occurs in a few people who take statins, so many people take these medications that it is important to be aware of the risk.
The syndrome can also be caused by exposure to other drugs, certain toxins, and high levels of alcohol. Other drugs than can cause rhabdomyolysis include:
• cyclosporine
• erythromycin
• colchicine
• cocaine
• amphetamines
• ecstasy
• LSD
There are many other potential causes in these four categories beyond those listed.
Part 3 of 7: Symptoms
Recognizing the Signs of Rhabdomyolysis
The initial symptoms of rhabdomyolysis can be subtle. They are not specific and may mimic other conditions.
Your affected muscles will likely feel weak. You may have an intense ache at the site of the affected muscles. The muscle may be tender to the touch and swollen, and you may see bruising.
You will likely have dark, tea-colored urine. You may urinate less often. Fever is common, along with a general sense of malaise or “feeling sick.” You may experience vomiting and nausea as well as confusion and agitation. Sometimes you may notice weight gain. Some people feel joint pain. Seizures may occur in later stages of the condition.
One serious problem with muscle injury is “compartment syndrome.” Swelling inside of the muscle causes the tight bands that surround the muscle, called fascia, to block the blood flow into or out of a muscle. Blocking blood flow into a muscle can increase the amount of muscle damage.
Part 4 of 7: Diagnosis
How Is Rhabdomyolysis Diagnosed?
Doctors will look and feel the larger muscles in your body, especially any that ache, to see if there is tenderness or if muscle tissue has died off.
Urine and blood tests will be done to confirm the diagnosis. The presence of myoglobin in the urine is an important indication of muscle breakdown and rhabdomyolysis.
Blood tests may be done to determine muscle health and kidney health, including:
• creatine kinase (CK): increased CK indicates muscle damage
• myoglobin levels in blood and urine
• calcium, which may leak from injured muscles
• potassium
• CK isoenzymes—a form of creatine kinase
• creatinine (in blood and urine): high level indicates kidney damage
If a genetic disease is suspected as a cause for rhabdomyolysis, a test called a “forearm ischemic test” may be done. Blood is taken from a vein in the forearm, and then a tight blood pressure cuff is used to reduce the blood flow to the forearm. Then blood samples are taken again. Differences in the two samples may indicate a genetic problem that can make you very prone to developing rhabdomyolysis.